Trochleoplasty - The Ins and Outs

My surgery and rehabilitation

[lucyrussell8]

Two-and-half years later

Oops has it really been that long!!!! Wow how time flies! Well the good thing to say is that I haven't dislocated my knee since the surgery and I feel better than ever. Don't get me wrong, it's not perfect. I struggle with stiffness and cramps in the cold weather that make me feel like an old woman; cramps across my knee if I push it too hard or I get far too cold and the most horrendous cracking/crunching noises from my knee sometimes - again usually due to the cold or sitting awkwardly for too long!!! No one's fault but my own I think 🙈 But if someone gave me a time machine and said "knowing what you do now, would you do it again?" The answer has to be a resounding YES! My god those weeks of recovery are the worse thing in the world. I ended up having 4 weeks off work and it was a further 6 weeks before I was confident (and stable) enough to get about with one crutches at all. My poor family had to put up with me turning the air blue and my foul temper in those first four weeks and my mood hit an all time low but once I was out of that funk, the road to recovery became easier and easier. But life is so much easier now without having to constantly think - is this going to strain my knee? Can I do this or that? Can I kneel down? - I can now but just not for very long otherwise I seize up. Last Christmas my parents took me ice-skating for the first time since I was very little and I ended up bursting into tears in the middle of the rink because I could skate without having to worry about someone colliding into me and dislocating my knee. I'm not the best, fittest or wisest person in the world but this certainly changed my life and for the better. I know there are those of you out there that will be reading this in preparation for your own operations or having just recently had them. If you want advice, information or just someone's brains to pick - ask!!! I'm more than willing to give you all the help that I can. Lucy

[lucyrussell8]

Bandage off

Woo! Two weeks down and the bandage is off!!

Well, almost! I have a temporary one on so I can have a proper shower but then I have to take it off so that the scar can air and remain dry.

Mum thinks the scar is about 6 1/2 - 7 inches long, although it curves around my knee so we’re not quite sure.

The nurse was pleased with it and when mum made the time old joke of ‘you’ll be scared for life’ the nurses said that actually the wound was very neat and small and would simply face away to nothing over time.

My response? YES!!

[lucyrussell8]

Service stations

So on the way home, we decided to stop at a service station and have a comfort break and a stretch of cramped legs (mums in particular). So we drove up near to the entrance to minimise the distance I had to walk. Here's the dilemma. I had got into the car, but now how do I get out? As you may have read previously.... We 'extended' the car with suitcases........ So, your on crutches right? And you still have those annoying sweating, sticky hospital bands around your wrists - so people are going to get out of your way. Right? Nope Not one bit. Between the front door and the loos I must have had 6 people almost walk into me despite my mum and nan acting as guards on either side! 20 minutes later just as I almost reached the disabled toilet (enough space to accommodate my useless leg), a woman pushing a wheelchair zooms past me almost bowling me over to race me there first! Needless to say nan wasn't pleased and quickly commandeered the baby changing one for me (hehe). Of course it wasn't long before a screaming baby could be heard outside with nan calmly saying 'it's occupied'. A 20 minute return journey to the car with only 4 attempts on my life this time although one did come very close to making me fall over. Actually walking across and into me in their haste to get in the services. Needless to say mum and nan glared daggers at the poor fool!

[lucyrussell8]

Car journeys

My god, if you get this wrong it hurts.

Trust me: an hour and 15 minutes of trial and error, screaming, swearing, painkillers and tears upon my discharge from hospital. 

Here is a list of things to and not to do:

1. Get in the back - Here you will have room to stretch your leg out as you please.

My technique is to get in the side of your bad leg (so I had right knee surgery so I got in on the right side of the car). Turn around as if you are going to sit on a chair and (mind your head!) sit down. Pass off your crutches to your trusted assistant and using your well practiced technique of good foot under bad ankle lift your leg up and lay back slightly. Use the seat backs and any handles you can to slide you bum backwards on the seat. Your will probably find that once your calf is on the seat you can take your good leg out. Use your good one to push on the floor to help you slide back. Slide back as far as you can into the corner. I found that moving my leg so that my foot was hanging off the seat towards the foot well was more comfortable than having my leg fully on the seat but that might just be a personal preference. 

2. Make sure you have no more than three of your traveling back in the same car - Driver, one in the front and you - trust me I made this mistake and it was hard work trying to get both me, my leg and my mum in the back. She became some kind of contortionist in order to accommodate my leg and her in the same seat space. Don’t ask how, we still aren’t quite sure…………..

3. Have your painkillers close on hand - you might not need them, then again you might, it’s not the easiest of maneuvers.

4. Have something to ‘extend’ the car with - I know this sounds crazy but hear me out. How are you going to get your leg out of the car without bending your knee?

My solution was suitcases piled up to the seat height, then shuffle out keeping your bad leg straight and use your good one for leverage on the floor/door frame. Put your bad one on the suitcases and using a wiggle of your ankle and SLOW shuffle movements edge your foot (and bum) further onto the cases and out of the car. Then once you are far enough out, put your good leg on the ground and push up using the door and back of the seat or crutch. As you do this, push your leg/foot forward so that your foot is on the floor and get someone to CAREFULLY pull the cases out of the way and voila! You are out pain(ish) free!

[lucyrussell8]

Physiotherapy - Week 1

Some of the exercises that the physios will give you to do, actually work and you can do them. Others, keep them away - as far away as you can!

With all of these I would strongly suggest either having ice on hand for afterwards or placing ice on your knee as you carry them out - especially the 'skateboarding' and 'towel' ones. 

Ankle up, knee down - Lift your ankle up and push your knee into the mattress whilst lying down - this one I can do and I can feel the slight pull on my muscle, even if I can't get my ankle off the mattress.

The 'skateboard' or 'apron' one - sliding your bad foot across the floor as far back as you can get it to go. Make sure you are on a high enough chair for this one and have something to measure your progress with. I use one of my crutches on the floor with the base on the leg of the chair and measure how many of the spaces I can get my foot back to. 

The 'towel' one - Whatever you do, DO NOT follow what the physio wants you to do. If the physio comes in with a LARGE rolled up towel and tries to put it under your knee, flat out tell them no. 

I promise you now, that will be one of the most painful things you ever experience. Physio's don't understand the operation that you have just had and as such think that it is ok to try and bend your knee straight away - I'm sorry I've just had a piece of my BONE cut out, I think that is going to hurt!!!

Instead do this - take a SMALL towel and roll it up as flat as you can. Now lift your bad leg up (with the good one) and get someone else to place the towel under your knee. Slowly lower your leg onto the towel and support your bad ankle with your good one.

Put the ice on now if it isn't already on.........

Now slowly lower your good foot so that you being to bend your bad knee - push yourself a little but don't over do the pain. The idea is to stretch the muscles not tear them.

If you can get your good foot flat on the bed, try taking it out from underneath the bad one and letting the bad one rest on the bed instead. If you can, see how long you can leave/hold your leg here for before it becomes to much.

The next day, try rolling the towel so that it is a little fatter and try again. See how much you can do! 

[lucyrussell8]

Bandages

Plaster cast - Nope

Crepe bandages - Only right after the surgery

...... Right, so what do you have then.

Well a bit of tape holding the cut skin together with a waterproof plaster over the top and a piece of tubigrip. 

Yes that's right, all that major surgery and all I have supporting my knee is a piece of tubigrip........................... Okay 

[lucyrussell8]

Recovery Day 4 - Stairs again and discharge

Sunday

Finally the day off my release has arrived! Although I must complete the dreaded stairs again before I can go. 

Although I have only done them once before, I find them a lot easier the second time around - practice? Knowledge? Less pain? Who knows it just was. 

Discharged by the nurse (eventually) and told I have to wear these ridiculous compression stockings for the next four weeks.......WHAT!!!

[lucyrussell8]

Recovery Day 3 - The skateboard and the stairs

Saturday

Skateboard - Say what? I’m not as crazy as you think. Well, the physio isn’t as crazy as you think anyway. 

Sitting in the chair and moving your foot/knee with an apron on the floor it actually quite hard. So the physio’s solution - a plant pot mover (think it's crazy yet?)

I’m not joking - it actually works!!!!! 

Much easier to move your foot with one of these things under it. 

Stairs - Man’s worst invention for those with knee problems……

The physio’s will teach you how to do these, and they are one of the most daunting things you have to accomplish before they release you. 

Here’s how you do them: 

UP

Stand at the bottom on the same side as your rail (if you have two pick one), have one crutch on the other side. 

Using the rail and the crutch to push/pull against. Lift your GOOD leg up onto the step. 

Now push/pull on the rail/crutch and lift/bend your BAD leg up onto the step. Then move your crutch up onto the same step. 

Now repeat for the rest of the flight. 

DOWN

Stand at the top on the same side as your rail with a crutch in the other hand. 

Hold onto the rail and place your crutch down one step. 

Use the crutch and the rail to lean on step down with your BAD foot. 

Now step down with the GOOD one. Move the crutch down a step and repeat. 

[lucyrussell8]

Femoral Nerve Block

Ok, so I have mentioned this a few times now but I haven't actually explained it. 

Basically, everyone knows the femoral artery right? Well there is a nerve that runs along side it called the femoral nerve. The idea of this block is to place local anesthetic as close to the nerve as the can to numb the pain receptors in the knee. 

It's well....... awkward to say the least. 

The anesthetist ultrasounds your groin to find the femoral nerve and then places a probe into your leg and runs a current through it - this causes the muscles in your leg to twitch and depending on the location of the twitch, tells the anesthetist if they need to move the probe or not.

Then when they have to right area they inject local anesthetic in. 

Don't worry before they do any of this they will give you a sedative, this takes away most of your pain and makes it a lot less awkward. 

They will tell you that it will wear off in about 8 hours time. Mine was given at 7pm Wednesday night and it didn't wear off until 1pm Friday........8 hours right.

[lucyrussell8]

Recovery day 2

Friday morning - This was ok, Up and about with the physio's again, down the corridor a little way this time!

Friday afternoon - Not so good............. Just after lunch my femoral nerve block ran out. Ouch...........................................................

Two hours late with 2x shots of oral morphine, 3x tramadol (halfway between morphine and paracetamol), 4x paracetamol, 2x ibuprofen, 1x diclofenax (stronger ibuprofen) - a lot of shouting, crying, swearing and hurling tissues and teddies across the room (I promise you this made me feel a lot better afterwards!) the pain finally subsided to a manageable level. Either that or I was just so exhausted from it that I stopped noticing it..... :/ 

Needless to say I napped after dinner but then had a rather restless night 

[lucyrussell8]

Getting in and out of bed

This is, well.............hardwork.

In and out - both ways hurt I'm not going to lie. 

My best tip is whatever you do, DON'T let ANYONE hold, touch or guide your ankle. They always do it "wrong" and you'll end up screaming in pain or frustration at them. If you are in charge of your own leg/knee then you control it entirely. 

Here's what I learnt (remember this is for my RIGHT knee so swap it round if your surgery is for your left):

IN

Sit on the edge of the bed with your left leg bent and your right out in front wherever is comfortable. 

Then - using your foot, wiggle your right leg towards the end of the bed carefully until you think you can go no further. 

At this point I normally shift my left leg up onto the bed and wiggle my right a little further - but only do this if you feel comfortable and you are not going to cause any pain in your knee. 

Then hook your left foot under your right ankle and as you lean back swing your left leg up onto the bed pulling your right with it. I often grab the other side of the bed for leverage. 

I end up laying down, once I have managed to get both up and be warned, the first few times you do this is will still hurt. 

Then CAREFULLY wiggle your left foot out from under your right one and lay it down on the bed. Then sit up and slide/wiggle/move yourself up/around the bed till your comfy.  

OUT

Wiggle yourself as close to the edge of the bed as you can - without falling out!

Then like on the way in, hook your left foot under your right ankle and lift. As you lift it, swing your hips/bum/foot off the side of the bed and GENTLY lower your foot to the ground. 

Then find your crutches and use them to leaver yourself up to a standing position. 

[lucyrussell8]

Recovery day 1

Apart from being stiff and sore, well actually I felt pretty good!

Still a little groggy from the anesthetic, breathing oxygen through the nose tube (a hospital requirement unfortunately!) and drugged up to my eyebrows on painkillers. 

The nurses had been about during the night on their stats rounds waking you up and subjecting you to arm squeezing pressure (I swear I came home with a bruised arm not a bruised leg!). 

It didn't take long for the physio's to come around and have me up and about - walking and weight-bearing to the door and back. 

This wasn't tooooo hard, considering that I still had the anesthetic from the femoral nerve block in my knee making the pain next to nothing anyway. 

The physio's also had me sat up in the chair with a plastic apron under my foot trying to inch it backwards from straight out to a 90 degree bend - let me tell you now, that isn't going to happen any time soon.........

Back into bed and sound asleep before 7 o'clock

[lucyrussell8]

The surgery itself

Let me explain what happened to me (If you are squeamish I would suggest not reading this part!)

First they cut the skin and muscle until they reach the bone. 

Then they push the kneecap out of the way (generally towards the inside of the leg) and peel the cartilage off of the tibia and out of the way. 

Next, they cut the bump/dome off and cut a groove into the bone. 

Then they reattach the cartilage and move the kneecap back into place. 

In my case (and I am unsure if everyone undergoes this part) they then used a combination of tape and pins to pull my medial muscle (the muscle on the inside of your knee) tighter to help stabilize the joint and provide more strength. 

Then they stitch you back up again and wheel you off to recovery!

[lucyrussell8]

Trochleoplasty - Say What?

That’s what I first said when I was told the name of the operation.

It is still classed as an ‘experimental’ operation with Mr Eldridge himself only having performed just over 400 operations in the last 10 years despite having the second largest completion list. 

Trochleoplasty’s are not suitable for all knee dislocations but in some people, the groove that the kneecap sits in (the trochlea) fails to form, leaving a bump/dome instead.

A trochleoplasty involves cutting the tibia to create a groove although it generally isn’t that simple. 

[lucyrussell8]

Pre-surgery

Having seen him in November 2013, Mr Eldridge explained my problem. Instead of having a normal groove in my tibia for my kneecap to sit in, I instead had a dome. This makes it far easy for the kneecap to slide out of place. I also had weak ligaments and muscles surrounding the kneecap due to the number of dislocations that I had suffered in my younger years. 

I was scheduled into the books to be operated on in the spring/summer of 2014. The original date was set to be the 23rd of May at Southmead hospital in Bristol however the new site and operating theatres were not yet operational and as such I received a phone call on the 21st detailing the change in plans (half an hour before one of my end of term exams!)

On the 4/6/14 I was admitted to the spire hospital in Bristol called the Glen. My consultant, Mr Eldridge, was to perform a very complex and major piece of surgery on my knee that evening. I was to undergo a 'trocheloplasty' on my right knee.  

[lucyrussell8]

Dislocating my knee

When I was 12 i dislocated my right knee for the first time doing shuttle runs in a P.T. session at Air Cadets. For the next 6 years I repeatedly dislocated my knee 3-4 times a year under a variety of circumstances. Sports, pressure, twisting, falling, jumping, sliding and on one memorable occasion for no reason at all! 

  In September 2012 I went off to university in Southampton and for the first four months everything was great. Until…. one night we had gone out to a club and, yes being drunk, I managed to fall over on the slope leading from one area to another. It didn’t take long for the pain and the realisation to dawn that I had once again ‘done my knee in’ as my family call it. Nevertheless I managed to call and find my friends and get into a taxi and head off to a&e. 

  7 hours later…. We finally arrived back at halls, exhausted, hungover and me in a plaster cast. I was given an appointment to see an orthopedic surgeon to have the cast off and to be examined. 

  Mr Hancock was a lovely doctor, spoke in words you could understand and seemed sympathetic to my plight. I was taken out of the plaster and given a leg brace to wear for four weeks. 

  That was all well and good until I (foolishly I know!) let my mates persuade me into coming out with them one night on the grounds that I would wear my brace and flat shoes. 

  Four hours later we were back in a&e - someone had stood on my foot with their stiletto heel and the shock and pain had caused my to wrench my foot out from under her shoe - wrenching is never good for dislocatable knees…………..

  Back into (a far more substantial) cast again and before I could say ‘wait’ mum had hauled be back home with a sound telling off to recover and be looked after at home. 

  Many x-rays, MRI’s and hospital visits later we finally caught up with Mr Hancock again. His verdict? He had absolutely no idea what to do to fix it.

  He suggested bring up my case at the quarterly orthopedic south west surgeons meeting to see what others had to say and we readily agreed. Lots of brains are better than one! 

  On his return we were told that I was going to be referred to Mr Jonathan Eldridge in Bristol. A world-class knee specialist working in the most advanced areas of current knee surgery.